Provider Demographics
NPI:1104131028
Name:MI CASA NURSING SERVICES HOME HEALTH LLC
Entity type:Organization
Organization Name:MI CASA NURSING SERVICES HOME HEALTH LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BLANCA
Authorized Official - Middle Name:CASTILLO
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-664-3900
Mailing Address - Street 1:PO BOX 4079
Mailing Address - Street 2:
Mailing Address - City:ALICE
Mailing Address - State:TX
Mailing Address - Zip Code:78333
Mailing Address - Country:US
Mailing Address - Phone:361-664-3900
Mailing Address - Fax:361-664-3901
Practice Address - Street 1:701 N TEXAS BLVD STE A
Practice Address - Street 2:
Practice Address - City:ALICE
Practice Address - State:TX
Practice Address - Zip Code:78332-3883
Practice Address - Country:US
Practice Address - Phone:361-664-3900
Practice Address - Fax:361-664-3901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-16
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251E00000X
TX013683251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001020692Medicaid
TX001020692Medicaid